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Colorectal · London

Anal fissure surgery - private in London.

An anal fissure is a small tear in the anoderm that causes sharp, knife-like pain during and after bowel motions, often with bright red blood on the paper. Most heal with creams. When they do not, Botox injection or a lateral internal sphincterotomy in a day-case unit ends the pain and heals the fissure in over 95% of cases.

A stethoscope on a clinical desk

What it is

A small tear that will not let up.

An anal fissure is a linear tear in the anoderm, the sensitive lining just inside the anus. Most sit in the posterior midline. They are caused by a hard or explosive stool that splits the lining, and they persist because the exposed internal sphincter goes into spasm, which cuts blood flow and stops the tear from healing.

An acute fissure is under 6 weeks old and usually heals with fibre, water and topical creams. A chronic fissure has been present for more than 6 weeks, often with a sentinel skin tag at the outer end and a hypertrophied anal papilla at the inner end. Chronic fissures need something to break the spasm cycle: Botox, or surgical division of a small piece of the internal sphincter.

The condition is common, benign and highly treatable. The pain, however, is disproportionate to the size of the tear and can dominate daily life.

Symptoms

Sharp pain, then hours of aching.

  • Severe knife-like pain on defecation that lasts for minutes to hours afterwards, often described as passing broken glass.
  • Bright red blood on the toilet paper, small volume, clearly linked to the bowel motion. Never mixed into the stool.
  • A cycle of pain, fear of the toilet, constipation and harder stool that then splits the fissure open again.
  • Anal spasm so tight that a routine examination is often not tolerated without local anaesthetic.
  • Occasional itch or a palpable skin tag at the anal verge in chronic cases.

Indicative pricing

What private anal fissure surgery costs in London.

Indicative all-inclusive ranges across UK units.

In short

Botox £1,400–£2,200. LIS £3,500–£5,500. Advancement flap £4,500–£7,500.

Procedure Indicative range
Botox injection (internal sphincter) £1,400–£2,200
Lateral internal sphincterotomy (LIS) £3,500–£5,500
Fissurectomy + advancement flap £4,500–£7,500
Consultant consultation £200–£400
Follow-up review £150–£300

Prices vary by hospital, by consultant and by the complexity of your case. All figures include GA, day-unit stay and consultant fees.

The problem

The right anal fissure treatment, at the right time.

NHS pathways work but the wait is long, and by the time it is offered the fissure is often deeply chronic. Private care shortens the timeline and lets you choose the consultant.

  • NHS waits are long

    Colorectal outpatient waits stretch beyond 12 weeks in many trusts. Private care shortens this to days.

  • The right consultant matters

    Fissure outcomes track with subspecialty interest, not just hospital brand. A tailored partial sphincterotomy protects continence.

When it helps

When anal fissure surgery is the right step.

Situations where a procedure is a reasonable next step after conservative measures.

  • Chronic fissure over 6 weeks

    Creams failed, still bleeding and in pain.

  • Severe knife-like pain on stool

    Cycle of pain-avoidance-constipation.

  • Bright red blood on paper

    Small volume, clearly linked to defecation.

  • Anal spasm on examination

    Tight, tender internal sphincter.

  • Recurrent fissure after healing

    Consider Botox or LIS as next step.

Treatment ladder

The steps, in order.

Start conservative, escalate only if the fissure will not heal. Every rung protects the sphincter more than the next.

  • Topical creams

    GTN 0.4% or diltiazem 2% for 6 to 8 weeks. First-line for most.

  • Botox injection

    20 to 50 units into the internal sphincter. Sphincter-preserving, day case.

  • Lateral internal sphincterotomy

    Gold standard for chronic refractory fissure. Small partial cut, healing above 95%.

  • Fissurectomy + advancement flap

    For posterior fissures, previous LIS or high incontinence risk.

Botox injection

A day-case, ten-minute procedure. 20 to 50 units of botulinum toxin injected into the internal anal sphincter under short GA or heavy sedation. Chemical relaxation of the sphincter lasts around 3 months, long enough for the fissure to heal in 60 to 70% of patients. No permanent sphincter change and no incontinence risk. Can be repeated.

Lateral internal sphincterotomy (LIS)

The gold standard for chronic refractory fissure. A 15-minute day-case operation under GA. A small, calibrated partial cut is made in the lower fibres of the internal sphincter through a 1cm lateral incision, breaking the spasm cycle. Healing rate above 95%. Minor flatus incontinence in 5 to 10%. Same-day discharge.

Fissurectomy + advancement flap

The sphincter-sparing alternative. Reserved for posterior fissures with a large sentinel pile, patients who have already had a LIS, and those at high incontinence risk (previous obstetric injury, IBD, low resting pressure). The fibrotic edges are excised and a flap of healthy anoderm advanced over the defect.

Where it is done

A small panel of London colorectal units.

Introductions are made privately, once we understand your case.

  • London Colorectal Clinic

  • HCA London Bridge Hospital

  • The London Clinic, Harley Street

  • Cromwell Hospital (Bupa Cromwell)

  • Nuffield Health Bushey

  • The Princess Grace Hospital

  • CQC-registered UK day units across London and the major cities

  • Direct insurer preauth handling for Bupa, AXA, Vitality, Aviva, WPA and Cigna

Recovery and safety

What to expect afterwards - honestly.

Recovery after LIS is quick. Most patients are back at a desk in 1 to 2 days. Sitz baths, a high-fibre diet and stool softeners for 6 weeks. The fissure itself heals over 3 to 6 weeks.

  • Incontinence risk

    5 to 10% minor flatus incontinence after LIS. Advancement flap avoids sphincter cutting.

  • Why creams fail

    Poor compliance, headache from GTN, deep fissure or high resting sphincter pressure.

  • Botox effect

    60 to 70% healing at 3 months. Temporary and reversible. Can be repeated.

  • Recurrence

    5 to 10% after LIS, higher after Botox. Diet and stool softeners reduce recurrence.

  • Bleeding

    Usually minor and self-limiting after LIS.

  • Time off work

    1 to 2 days for desk work after LIS. Sitz baths and high-fibre diet.

Reading your notes

Your report in four parts. Read the last one first.

Whichever centre performs the procedure, the report keeps to the same shape.

  1. 01 Header

    Indication and consent

    Why the procedure was done, what was consented and any relevant history.

  2. 02 Findings

    What was seen or done

    Fissure location, depth, sphincter tone, technique used, units of Botox or length of sphincterotomy.

  3. 03 Assessment

    Consultant interpretation

    What the findings mean in your clinical context.

  4. 04 Impression

    Summary and next step

    Read this first. Bottom line, aftercare and recommended follow-up.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Usually covered by UK private medical insurance when there is a specialist referral and documented failure of medical therapy.

Frequently asked

Everything we get asked about anal fissure surgery.

  • What is the incontinence risk after lateral internal sphincterotomy?

    Around 5 to 10% experience minor flatus incontinence or occasional soiling. Frank stool incontinence is rare, under 1% in modern series with a tailored partial sphincterotomy. Advancement flap is offered where risk is higher, for example previous LIS or obstetric injury.

  • Why did the GTN or diltiazem cream fail to heal my fissure?

    Common reasons are poor compliance from headache with GTN, incomplete 6 to 8 week course, a deep chronic fissure with a sentinel pile, or persistently high internal sphincter pressure. Botox or LIS is the logical next step.

  • Does Botox really work for anal fissure?

    Yes. 60 to 70% of chronic fissures heal at 3 months after a single injection of 20 to 50 units into the internal sphincter. It is a 10-minute day-case procedure with no permanent sphincter change, and it can be repeated.

  • What is the recurrence rate after anal fissure surgery?

    After LIS, 5 to 10% recur, usually because of ongoing constipation. After Botox, recurrence is higher at 20 to 30%. A high-fibre diet, stool softeners and adequate hydration are essential.

  • Is anal fissure surgery covered by UK private medical insurance?

    Usually yes with a specialist referral and a documented failure of medical therapy. Bupa, AXA, Vitality, Aviva, WPA and Cigna cover Botox injection, LIS and advancement flap under standard colorectal codes.

  • How long does it take to heal after LIS?

    Pain relief is usually immediate as sphincter spasm settles. The wound heals over 3 to 6 weeks. Most patients return to desk work after 1 to 2 days. Sitz baths twice daily and a high-fibre diet speed healing.

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